Insurance Ch 4 Flashcards
Traditional Medicare consist of hospital insurance protection (_______) and medical insurance protection (_______).
Part A/part B
All persons, age 65, and over, who are entitled to, but not necessarily receiving, monthly, Social Security, cash, benefits, or monthly benefits, under railroad retirement programs are eligible for Medicare _____.
Part A hospital insurance
A Social Security disability beneficiary _______ covered under Medicare after entitlement to disability benefits for 24 months or more.
IS
When a person has covered by an employer group, health insurance plan, is entitled to veterans benefits, or is covered by Worker’s Compensation, Medicare is the ______.
Secondary payor
Medicare part ______ is financed through monthly premiums paid by those who enroll plus contributions from the federal government. The patient pays a deductible first. Medicare pays ___ of the balance of the approved charges. No stop-loss applies, leaving the client with significant financial exposure.
Part B / 80%
Client exposed to 20% of an unlimited amount
Routine, dentures and dental care, exams for eyeglasses or hearing aids, most immunizations, prescription drugs are _____ Medicare part B.
Excluded from
Skilled nursing home stay and the hospital stay are Medicare _____ coverages.
A
Medicare B coverage for prescription drugs is limited to ______.
Drugs which cannot be self administered.
Medicare _______ refers to plans run by insurance companies approved by Medicare.
 Drug manufacturers must generally provide a ______
Part D / 50% discount
______ policies are only available to individuals currently enrolled in both Medicare part A and part B.
Medigap
A(n) _______ provides a wide range of comprehensive healthcare services to a group of subscribers in return for payment and delivery features for a fixed premium.
HMO. Health maintenance organization.
A monthly fee is paid to the provider. In return, the individual receives virtually all the medical care required during the year.
Capitation
Care is managed by a primary care physician, who is responsible for determining what care is provided, and when the individual should be referred to specialist
Gatekeeper
True or false:
The subscriber is covered when he/she uses a provider other than the HMO
False
Besides having to go through a gatekeeper, the subscriber is not covered when he/she uses a provider other than the HMO, unless for an emergency.
Healthcare providers in the _______ are generally paid on a fee for service basis as needed
PPO preferred provider organization
Subscribers are not required to use practitioners or facilities of the _____. They can go outside of the network, but benefits are generally reduced relative to benefits paid for network, provided care.
Preferred provider organization
PPO
With regards to group, medical insurance, premiums for employees’ and employees’ dependents’ coverage are ______ by the employer.
Tax deductible 
If the COBRA triggering event is termination, the employee and the employee’s spouse and dependents have coverage for up to _______.
18 months.
If the COBRA, triggering event is divorce, the employee’s spouse can be covered under the group health insurance policy for up to _____.
36 months
Savings accounts that operate alongside a high deductible health plan.
Health savings accounts (HSAs)
Contributions by individual to an HSA are _______ for federal income tax purposes.
Deductible
Employer contributions to an HSA are ________.
Tax deductible by the employer
Distributions from HSAs can be for healthcare, needs not covered by the high deductible policy and are ______.
Tax-free
Penalties for non-medical HSA withdrawals are now ______ of the distribution, if under age 65.
20%
Money remaining in an HSA account at age 65 or older that is withdrawn for a purpose. Other than healthcare is _______.
Taxed at ordinary income tax rates.
There is no 20% penalty when the insured reaches the age of Medicare eligibility.
Over-the-counter drugs now ____ qualify as an eligible medical expense
Do
If an employee drops healthcare coverage because he is eligible for Medicare, his family (not him) may elect COBRA coverage for _____ months.
36
The COBRA election period starts with the date of the _______ and lasts for _____ days.
Notification / 60
